Name				Order Date
Address				Telephone
City		State	Zip	Fax
E-mail

Credit Card Number Exp. Date

Pay using VISA	Ship Ground UPS	Substitutes OK
Pay using MasterCard	Ship U.S. Mail	Do NOT substitute

Quantity	Item#	Color and Description	Unit Price	Amount
			Subtotal
		Handling Fee, If Subtotal is less than $50.00
		Shipping Charges
			Total

Order Notes or Suggestions